On The Hill

As the impeachment inquiry into President Trump continues to seize the headlines in Washington, Speaker Nancy Pelosi’s (D-CA) “Lower Drug Costs Now Act” continued atop healthcare matters for the week, as Congress began its first of two weeks in recess. Additional headlines included Ways and Means Chairman Richard Neal’s (D-MA) new approach to surprise billing and President Trump’s executive order expanding Medicare Advantage plans.

Surprise Billing

House Ways and Means Going Their Own Way on Surprise Billing

Chairman Neal is readying to pitch a new approach to tackling “surprise” medical bills, positioning it as a compromise after momentum on leading legislation has stalled amid fierce resistance from providers. In a letter to committee Democrats, Neal outlined the broad contours of a plan he recently offered to Ranking Member Kevin Brady (R-TX). The approach empowers the federal government, with stakeholder input, to determine payment rate standards — and consider an arbitration approach favored by providers — to prevent patients from receiving often sky-high bills for inadvertently receiving out-of-network care. Under Neal’s approach, three departments — HHS, Labor and Treasury — and stakeholders, would form a committee to identify standards for rates for surprise bills and decide whether to allow an option for providers and health plans to dispute payments. The committee will then send recommendations to agency secretaries to develop a proposed rule, with a comment period for more public feedback. Neal said he’s “optimistic” that Brady will support his approach. A spokesperson for committee Republicans said they “look forward to reviewing the details of this and other possible solutions.” Neal said committee staff will hammer out legislative text during the current two-week recess, adding that the panel is expected to consider it this month. He said it’s “imperative” to resolve the issue before year’s end. ^[1] 

Drug Pricing

House Progressives Want Changes to Pelosi Bill

House progressives are mounting a fresh effort to influence Democrats’ centerpiece prescription drug legislation, warning that the proposal risks falling short of expectations without a series of fixes to its core provisions. During a closed-door session last week, House Ways & Means Health Subcommittee Chairman Lloyd Doggett (D-TX) and Rep. Ron Kind (D-WI.), former chair of the moderate New Democrat Coalition, both questioned Speaker Pelosi’s haste to get the bill passed, according to multiple people in the room. Several Democrats have since noted that talking points handed out by leadership contained multiple inaccuracies — including a claim that the legislation lifts a clause banning Medicare’s ability to directly negotiate drug prices with pharmaceutical companies. While the bill does empower federal officials to negotiate the price of up to 250 drugs for the first time, it accomplishes that by creating an exception to the current prohibition, rather than eliminating it altogether. Some lawmakers fret that the nuance could fuel election-year attacks on Democrats for exaggerating the bill’s core benefits. The issues have prompted multiple Democrats to openly question Pelosi’s push for a vote by Halloween, and have stoked fears on the left that leadership might bypass needed vetting of its policies in pursuit of a quick political victory. Democratic leaders are planning to speed the bill through a trio of committees within days of Congress’ mid-October return from recess, setting the stage for a floor vote by the end of the month. ^[2] 

Trump Impeachment Inquiry

President Trump threw cold water on the possibility that House Democrats and the White House could work together to tackle the high cost of prescription drugs during the Democrats impeachment inquiry. “Nancy Pelosi just said that she is interested in lowering prescription drug prices & working on the desperately needed USMCA. She is incapable of working on either. It is just camouflage for trying to win an election through impeachment. The Do Nothing Democrats are stuck in the mud!” Trump tweeted. Trump’s response marked a sharp reversal from his statement in mid-September when Pelosi rolled out her drug pricing plan. At the time he declared, “It’s great to see Speaker Pelosi’s bill today. Let’s get it done in a bipartisan way!” Pelosi and White House aides met Tuesday for a briefing on the speaker’s drug bill, H.R. 3 (116) according to media reports. ^[3] 

Trump Executive Order

This week, President Donald Trump issued an executive order expanding private Medicare Advantage plans, as he tries to position himself as a defender of seniors’ health care ahead of the 2020 general election. Senior administration officials said the order will draw a direct contrast between Trump’s plans to bolster Medicare and support among Democratic candidates for “Medicare for All.” Trump officials said the executive order is aimed at beefing up Medicare and Medicare Advantage, boosting telehealth services and supplemental benefits offered by insurers, and ensuring that traditional Medicare isn’t promoted over Medicare Advantage. Trump will direct agencies to expand access to Medicare medical savings accounts and design a payment model that would let Medicare Advantage beneficiaries share in the program’s savings, such as through cash rewards or monetary rebates. The order also calls for the elimination of “burdensome” requirements that it says prohibit doctors from spending more time with their patients and for minimizing the time between FDA approval and Medicare’s determination of whether to cover the treatment.^[4] 

References

^[1] Roubein, Rachel. “Ways and Means readies new ‘surprise’ medical bill approach.” Politico Pro. 1 Oct 2019. https://subscriber.politicopro.com/article/2019/10/ways-and-means-readies-new-surprise-medical-bill-approach-1779886

^[2] Cancryn, Adam. “House progressives press for changes to Pelosi’s drug bill.” Politico Pro. 2 Oct 2019. https://subscriber.politicopro.com/article/2019/10/house-progressives-press-for-changes-to-pelosis-drug-bill-178093

^[3] Karlin-Smith, Sarah. “Trump shoots down Pelosi overture to keep drug pricing talks open during impeachment inquiry.” Politico Pro. 2 Oct 2019. https://subscriber.politicopro.com/article/2019/10/trump-shoots-down-pelosi-overture-to-keep-drug-pricing-talks-open-during-impeachment-inquiry-3945871

^[4] Roubein, Rachel. “Trump order to promote private Medicare plans, attack “Medicare for All.” Politico Pro. 3 Oct 2019. https://subscriber.politicopro.com/article/2019/10/trump-order-to-promote-private-medicare-plans-attack-medicare-for-all-3953318